=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780535757
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SERENITY MENTAL HEALTH AND WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2026
-----------------------------------------------------
Last Update Date | 02/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15615 HONEYBELL DR
-----------------------------------------------------
City | WINTER GARDEN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34787-5065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-986-1046
-----------------------------------------------------
Fax | 689-348-7003
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2212 S CHICKASAW TRL STE 1069
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32825-8414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-986-1046
-----------------------------------------------------
Fax | 689-348-7003
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED MENTAL HEALTH COUNSELOR
-----------------------------------------------------
Name | MRS. KALIMA THEMA JACKSON-WILLS
-----------------------------------------------------
Credential | LMHC
-----------------------------------------------------
Telephone | 407-986-1046
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------